PB2311: EFFICACY EVALUATION AND SAFETY ANALYSIS OF ZANUBRUTINI B COMBINED WITH CHEMOTHERAPY FOR 17 CASES OF RELAPSED REFRACTORY DIFFUSE LARGE B-CELL LYMPHOMA
Authors: Qingfeng Chen, Yanyan Qiu, Chenxi Qiu, Haiying Fu, Tingbo Liu
Journal: HemaSphere (2023)

Topic: 19. Aggressive Non-Hodgkin lymphoma - Clinical Background: Diffuse large B-cell lymphoma (DLBCL) is the most common histologic sub type of aggressive lymphoma, accounting for approximately 30% of adult non-Hodgkin’s lymphomas (NHL). With the first-line standard regimen R-CHOP (rituximab, cyclophosphamide, adriamycin, vincristine and prednisone), more than half of the patients achieve effective remission. However, 30-40% of patients are still not cured after first-line therapy. The prognosis for patients with relapsed or refractory diffuse large B-cell lymphoma (RR DLBCL) is extremely poor. Currently, there is no standardized treatment protocol for this group of patients with relapsed or refractory diffuse large B-cell lymphoma. It is critical to explore effective novel salvage therapy options for this group of patients. Zanubrutinib is a novel irreversible inhibitor of Bruton’s tyrosine kinase (BTK). There are only a few studies on the use of zanubrutinib in patients with RR DLB Aims: This study was designed to evaluate the efficacy and safety of the zanubrutinib combination regimen in patients with RR DLBC Methods:Patients with RR DLBCL who were treated with the combination of zanubrutinib from January 2021 to October 2021 at the Union Hospital of Fujian Medical University were retrospectively collected. all patients received at least 6-8 courses of zanubrutinib combination regimen. The combination regimen included R-CEOP (rituximab, cyclophosphamide, epirubicin, vincristine, prednisone), R2 (rituximab, lenalidomide), R-Gemox (oxaliplatin, gemcitabine), and ZR (cidarabine, rituximab). ctDNA testing was performed in 17 patients. 4 cycles and 8 cycles after PET-CT or CT were used to assess response. Results:There were 17 cases of RR DLBCL with median age of 59 (18-80) years.. 8 (47.1%) patients were women The median follow-up time was 14 months (10-21). At the time of diagnosis, 52.9% (n=9) patients were presented with Ann-Arbor stages III-IV, 76.5% (n=13) were identified with the non-GCB subtype, 29.4% (n=5) patients exhibited double expression, and 17.6% (n=3) patients primary central nervous system lymphoma,70.6% (n=12) had extra-nodal disease,41.2% (n=7) had relapsed disease, and 58.8% (n=10) had refractory diseases. (Table 1). All patients had undetectable mutations after receiving 8 cycles of zanubrutinib combination regimen. The follow-up period ended on October 1, 2022.At the end of treatment, 70.6% (n=12) achieved a CR.the ORR and DCR were 70.6% and 70.6%, respectively. No patient died. The median PFS was16 months (95% CI: 13.2-19.0), the median time to CR of 4 months, and median OS was not estimable.Neutropenia (n=11, 64.7%) and were the most common grade 3/4 adverse events. The most non-hematologic adverse events were fatigue (n=2,11.8%), nausea and vomiting (n=8, 47.1%).No death due to adverse reactions occurred Summary/Conclusion:Zanubrutinib combination therapy has a high remission rate in RR DLBCL. Serious adverse reactions were less frequent and zanubrutinib treatment was tolerable during in patients with RRDLBCL.Keywords: Diffuse large B cell lymphoma, DLBCL, B cell lymphoma